Saving the Safety‐Net Hospital: Entangled Rhetorics of Life and Death in Hospital Advertising

• DOI: http://doi.org/10.1002/wmh3.318
• Author: Liz Hutter
• Published date: 01 December 2019
• Date: 01 December 2019

340

doi: 10.1002/wmh3.318

© 2019 Policy Studies Organization

Saving the Safety‐Net Hospital: Entangled Rhetorics of

Life and Death in Hospital Advertising

Liz Hutter

This article examines the public discourse around Grady Memorial, a safety‐net hospital in Atlanta,

GA, navigating financial vulnerability, its historical obligation to provide health care for the un-

derserved, and the conflicting needs of its diverse stakeholders. Using a rhetorical analysis I examine

the use of near‐death metaphors to frame the complexity and precarity of Grady’s situation in coverage

of its near‐closure crisis in 2007 and in an iteration of its 2013 advertising campaign. The analysis

shows that while saving patients’lives and saving the livelihood of health‐care institutions are

interdependent processes, the language and images used to talk about Grady prioritize its role as a

medical provider over its importance as a civic institution. In order to sustain both the medical and

civic support a safety‐net hospital provides its community, an implication of the analysis suggests the

need for systematic research to understand stakeholders’attitudes and perceptions toward its health‐

care institutions.

KEY WORDS: hospitals, advertising, life saving

Introduction

A prominent challenge in the current era of U.S. health reform is sustaining the

financial viability of safety‐net hospitals, while also ensuring their commitment to

provide care for the vulnerable and underserved (Hall & Rosenbaum, 2012,

pp. 2–3). Collectively, in 2017, U.S. safety‐net institutions provided $6.7 billion in

uncompensated care (Clark, Roberson, & Ramiah, 2019, p. 8); these institutions,

however, are burdened with operating margins totaling 1.6 percent and typically

do not generate large amounts of revenue (Clark et al., 2019, p. 8). With passage of

the 2010 Patient Affordable Care Act (ACA), some 20 million people have become

eligible for and acquired health insurance (Chokshi, Chang, & Wilson, 2016,

p. 1791). Under the ACA the cost of uncompensated care has decreased from $34.9

billion in 2013, to $28.9 billion in 2014 (Chokshi et al., 2016, p. 1790). Nonetheless,

when the ACA is fully implemented, an estimated 28–31 million people will still

remain uninsured (Chokshi et al., 2016, p. 1791), particularly those unable to afford

high insurance premiums, the poor, underemployed people, and undocumented

immigrants (Bazzoli & Garland, 2012, p. 195). As implementation of the ACA un-

folds, short‐term stability and the long‐term viability of the safety‐net health‐care

system is of ongoing interest to researchers, policymakers, administrators, practi-

tioners, and community members.

This article examines Grady Memorial Hospital (hereafter referred to as

Grady), a 125‐year‐old institution in Atlanta, GA, as an example of an urban safety‐

net institution managing its status as a financially strained, socially necessary

public health‐care institution. In 2007, Grady’s crisis of near closure generated

intense public debate among the hospital’s array of stakeholders regarding the

hospital’s viability as a medical institution and its vitality as a prominent civic

institution in Atlanta. Although closure was averted when in 2008, the hospital’s

leadership was transferred to a not‐for‐profit corporate board, uncertainty about

the hospital’s stability emerged again following passage of the ACA and Georgia’s

refusal of Medicaid expansion (Blau, 2013a, 2017).

Applying a rhetorical analysis to the representation of Grady in the news and

in its advertising, my analysis shows that saving the lives of patients and saving the

livelihood of health‐care institutions are interdependent processes. I argue that the

metaphors used in the news and in the hospital’s advertising to frame Grady’s

crisis can shape how the hospital’s political, economic, and community stake-

holders understand the complexity of Grady’s problem, and in turn, determine

what interventions to use to address it. Framing Grady’s near‐closure crisis as a

metaphor of surviving near death orients public dialogue to prioritize financial

interventions as the necessary solution to restoring the stability of the hospital’s

operations. Alternately, when the crisis is framed as a metaphor of thriving near

closure, stakeholders recognize Grady’s survival is dependent on numerous factors

that include maintaining a steady revenue stream as well as supporting dedicated

urban infrastructure to care for the city’s current and future residents. An im-

plication of my analysis is to suggest that cultivating more inclusive stakeholder

dialogue and examining more systematically a community’s attitudes and per-

ceptions toward its public health‐care institutions can guide researchers, policy-

makers, and legislators to develop different interventions to save the hospital’s

financial viability, while sustaining its role in the lives of Atlanta’s diverse

communities.

To develop my analysis, I first provide an overview of the financial and social

pressures Grady faced in 2007, in order to show the complexity or wickedness of

Grady’s situation. I then examine the biomedical and biosocial metaphors of sur-

vival in news coverage of the hospital’s crisis and in the hospital’s 2013 iteration of

its “I can’t live without Grady”advertising campaign. The paper concludes with a

recommendation for researchers and policy makers to seek pathways to better

understand not just the financial dilemma of safety‐net hospitals, but to also ex-

amine the perception of these institutions as valuable civic institutions essential to

all of a city’s residents.

Defining Grady Hospital’s Financial and Social Crisis—A Wicked Problem

Grady Memorial, ranked within the top 10 largest U.S. public hospitals, man-

ages an operating budget that averages annually $760 million and supports more

than 30,000 adult admissions, 312,000 outpatient visits, and 141,000 emergency

room visits (“Grady Fast Facts,”n.d.). With over 950 beds, Grady anchors the

Hutter: Saving the Safety‐Net Hospital 341